Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 52
Filter
Add filters

Document Type
Year range
1.
Sci Rep ; 11(1): 21124, 2021 10 26.
Article in English | MEDLINE | ID: covidwho-1493211

ABSTRACT

Patients with coronavirus disease 2019 (COVID-19) can have increased risk of mortality shortly after intubation. The aim of this study is to develop a model using predictors of early mortality after intubation from COVID-19. A retrospective study of 1945 intubated patients with COVID-19 admitted to 12 Northwell hospitals in the greater New York City area was performed. Logistic regression model using backward selection was applied. This study evaluated predictors of 14-day mortality after intubation for COVID-19 patients. The predictors of mortality within 14 days after intubation included older age, history of chronic kidney disease, lower mean arterial pressure or increased dose of required vasopressors, higher urea nitrogen level, higher ferritin, higher oxygen index, and abnormal pH levels. We developed and externally validated an intubated COVID-19 predictive score (ICOP). The area under the receiver operating characteristic curve was 0.75 (95% CI 0.73-0.78) in the derivation cohort and 0.71 (95% CI 0.67-0.75) in the validation cohort; both were significantly greater than corresponding values for sequential organ failure assessment (SOFA) or CURB-65 scores. The externally validated predictive score may help clinicians estimate early mortality risk after intubation and provide guidance for deciding the most effective patient therapies.


Subject(s)
COVID-19/diagnosis , COVID-19/mortality , Intubation, Intratracheal/methods , Severity of Illness Index , Adolescent , Adult , Age Factors , Aged , Arterial Pressure , COVID-19/therapy , Female , Ferritins/blood , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , New York , Nitrogen/metabolism , Oxygen/metabolism , Predictive Value of Tests , ROC Curve , Regression Analysis , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Vasoconstrictor Agents/pharmacology , Young Adult
2.
Proc Natl Acad Sci U S A ; 118(41)2021 10 12.
Article in English | MEDLINE | ID: covidwho-1486398

ABSTRACT

The COVID-19 pandemic led to widespread mandates requiring the wearing of face masks, which led to debates on their benefits and possible adverse effects. To that end, the physiological effects at the systemic and at the brain level are of interest. We have investigated the effect of commonly available face masks (FFP2 and surgical) on cerebral hemodynamics and oxygenation, particularly microvascular cerebral blood flow (CBF) and blood/tissue oxygen saturation (StO2), measured by transcranial hybrid near-infrared spectroscopies and on systemic physiology in 13 healthy adults (ages: 23 to 33 y). The results indicate small but significant changes in cerebral hemodynamics while wearing a mask. However, these changes are comparable to those of daily life activities. This platform and the protocol provides the basis for large or targeted studies of the effects of mask wearing in different populations and while performing critical tasks.


Subject(s)
Brain/physiology , Masks , Activities of Daily Living , Adult , Brain/blood supply , Brain/metabolism , COVID-19/prevention & control , Female , Healthy Volunteers , Hemodynamics , Humans , Male , Microcirculation , Monitoring, Physiologic , Oxygen/metabolism , SARS-CoV-2 , Spectroscopy, Near-Infrared , Young Adult
3.
Anaesthesia ; 76(11): 1546-1547, 2021 11.
Article in English | MEDLINE | ID: covidwho-1455502
4.
Proc Natl Acad Sci U S A ; 118(41)2021 10 12.
Article in English | MEDLINE | ID: covidwho-1450314

ABSTRACT

The COVID-19 pandemic led to widespread mandates requiring the wearing of face masks, which led to debates on their benefits and possible adverse effects. To that end, the physiological effects at the systemic and at the brain level are of interest. We have investigated the effect of commonly available face masks (FFP2 and surgical) on cerebral hemodynamics and oxygenation, particularly microvascular cerebral blood flow (CBF) and blood/tissue oxygen saturation (StO2), measured by transcranial hybrid near-infrared spectroscopies and on systemic physiology in 13 healthy adults (ages: 23 to 33 y). The results indicate small but significant changes in cerebral hemodynamics while wearing a mask. However, these changes are comparable to those of daily life activities. This platform and the protocol provides the basis for large or targeted studies of the effects of mask wearing in different populations and while performing critical tasks.


Subject(s)
Brain/physiology , Masks , Activities of Daily Living , Adult , Brain/blood supply , Brain/metabolism , COVID-19/prevention & control , Female , Healthy Volunteers , Hemodynamics , Humans , Male , Microcirculation , Monitoring, Physiologic , Oxygen/metabolism , SARS-CoV-2 , Spectroscopy, Near-Infrared , Young Adult
5.
Pan Afr Med J ; 39: 203, 2021.
Article in English | MEDLINE | ID: covidwho-1404090

ABSTRACT

Introduction: the COVID-19 pandemic has necessitated the prolonged use of facemasks by healthcare workers. Facemask non-compliance has been largely blamed on discomfort associated with the mask, and apprehension regarding potential health hazards such as asphyxia from mask usage. We sought to evaluate the impact of different respiratory mask types on the comfort of healthcare workers and their arterial oxygen saturation during periods of active clinical duty. Methods: we conducted a cross-sectional study on healthcare workers donning different types of facemasks in the normal course of duty. Objective non-invasive determination of arterial oxygen saturation of each participant was done using a portable pulse oximeter. Subjective self-assessment of global discomfort was scored by means of a 11-point numerical scale from 0 (no discomfort) to 10 (worst discomfort imaginable). The user's perceived elements of the discomfort were also evaluated. A statistical significance was accepted when P <0.05. Results: seventy-six healthcare workers completed the study, and wore the masks for periods ranging from 68-480 minutes. The discomfort experienced with the use of the N95 mask; 4.3 (2.0) was greater than the surgical mask; 2.7 (1.8); P=0.001. No significant change in arterial oxygen saturation was observed with the use of either of the mask types. The tight strapping of the N95 mask was perceived as a contributor to the discomfort experienced with mask usage; P=0.009. Conclusion: the N95 masks imposed greater discomfort than the surgical masks, but neither of the masks impacted on the arterial oxygen saturation of the healthcare workers.


Subject(s)
COVID-19 , Health Personnel/psychology , Masks/adverse effects , Oxygen/metabolism , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , N95 Respirators/adverse effects , Oximetry , Time Factors
6.
PLoS One ; 16(2): e0247414, 2021.
Article in English | MEDLINE | ID: covidwho-1388900

ABSTRACT

BACKGROUND: Facemasks are recommended to reduce the spread of SARS-CoV-2, but concern about inadequate gas exchange is an often cited reason for non-compliance. RESEARCH QUESTION: Among adult volunteers, do either cloth masks or surgical masks impair oxygenation or ventilation either at rest or during physical activity? STUDY DESIGN AND METHODS: With IRB approval and informed consent, we measured heart rate (HR), transcutaneous carbon dioxide (CO2) tension and oxygen levels (SpO2) at the conclusion of six 10-minute phases: sitting quietly and walking briskly without a mask, sitting quietly and walking briskly while wearing a cloth mask, and sitting quietly and walking briskly while wearing a surgical mask. Brisk walking required at least a 10bpm increase in heart rate. Occurrences of hypoxemia (decrease in SpO2 of ≥3% from baseline to a value of ≤94%) and hypercarbia (increase in CO2 tension of ≥5 mmHg from baseline to a value of ≥46 mmHg) in individual subjects were collected. Wilcoxon signed-rank was used for pairwise comparisons among values for the whole cohort (e.g. walking without a mask versus walking with a cloth mask). RESULTS: Among 50 adult volunteers (median age 33 years; 32% with a co-morbidity), there were no episodes of hypoxemia or hypercarbia (0%; 95% confidence interval 0-1.9%). In paired comparisons, there were no statistically significant differences in either CO2 or SpO2 between baseline measurements without a mask and those while wearing either kind of mask mask, both at rest and after walking briskly for ten minutes. INTERPRETATION: The risk of pathologic gas exchange impairment with cloth masks and surgical masks is near-zero in the general adult population.


Subject(s)
COVID-19/prevention & control , Masks , Oxygen/metabolism , Pulmonary Ventilation/physiology , Adult , COVID-19/psychology , COVID-19/transmission , Carbon Dioxide/metabolism , Exercise/physiology , Female , Heart Rate/physiology , Humans , Hypoxia/etiology , Hypoxia/metabolism , Male , Masks/adverse effects , N95 Respirators/adverse effects , Rest/physiology , SARS-CoV-2/isolation & purification , Walking/physiology
7.
BMC Res Notes ; 14(1): 20, 2021 Jan 09.
Article in English | MEDLINE | ID: covidwho-1388819

ABSTRACT

OBJECTIVE: We aimed to characterize the effects of prone positioning on respiratory mechanics and oxygenation in invasively ventilated patients with SARS-CoV-2 ARDS. RESULTS: This was a prospective cohort study in the Intensive Care Unit (ICU) of a tertiary referral centre. We included 20 consecutive, invasively ventilated patients with laboratory confirmed SARS-CoV-2 related ARDS who underwent prone positioning in ICU as part of their management. The main outcome was the effect of prone positioning on gas exchange and respiratory mechanics. There was a median improvement in the PaO2/FiO2 ratio of 132 in the prone position compared to the supine position (IQR 67-228). We observed lower PaO2/FiO2 ratios in those with low (< median) baseline respiratory system static compliance, compared to those with higher (> median) static compliance (P < 0.05). There was no significant difference in respiratory system static compliance with prone positioning. Prone positioning was effective in improving oxygenation in SARS-CoV-2 ARDS. Furthermore, poor respiratory system static compliance was common and was associated with disease severity. Improvements in oxygenation were partly due to lung recruitment. Prone positioning should be considered in patients with SARS-CoV-2 ARDS.


Subject(s)
COVID-19/therapy , Lung/metabolism , Prone Position , COVID-19/metabolism , Cohort Studies , Humans , Male , Middle Aged , Oxygen/metabolism , Prospective Studies , Respiration, Artificial
8.
Med Sci Monit ; 27: e930776, 2021 Oct 12.
Article in English | MEDLINE | ID: covidwho-1344551

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, patients presented with COVID-19 pneumonia of varying severity. The phenomenon of severe hypoxemia without signs of respiratory distress is also known as silent or hidden hypoxemia. Although silent hypoxemia is not unique to pneumonia due to SARS-CoV-2 infection, this phenomenon is now recognized to be associated with severe COVID-19 pneumonia. Proper management of critically ill patients is the key to reducing mortality. Herein, we summarize the possible and rare factors contributing to silent hypoxemia in patients with COVID-19. Microvascular thrombosis causes dead space ventilation in the lungs, and the flow of pulmonary capillaries is reduced, which leads to an imbalance in the V/Q ratio. The dissociation curve of oxyhemoglobin shifts to the left and limits the release of oxygen to the tissue. SARS-CoV-2 interferes with the synthesis of hemoglobin and reduces the ability to carry oxygen. The accumulation of endogenous carbon monoxide and carboxyhemoglobin will reduce the total oxygen carrying capacity and interfere with pulse oxygen saturation readings. There are also some non-specific factors that cause the difference between pulse oximetry and oxygen partial pressure. We propose some potentially more effective clinical alternatives and recommendations for optimizing the clinical management processes of patients with COVID-19. This review aims to describe the prevalence of silent hypoxemia in COVID-19 pneumonia, to provide an update on what is known of the pathophysiology, and to highlight the importance of diagnosing silent hypoxemia in patients with COVID-19 pneumonia.


Subject(s)
COVID-19/metabolism , Hypoxia/virology , Pneumonia, Viral/virology , Asymptomatic Diseases/epidemiology , COVID-19/epidemiology , COVID-19/virology , Humans , Hypoxia/epidemiology , Hypoxia/metabolism , Lung/cytology , Lung/metabolism , Lung/virology , Microvessels/metabolism , Oximetry , Oxygen/metabolism , Pneumonia, Viral/metabolism , Prevalence , SARS-CoV-2/isolation & purification , Thrombosis/metabolism , Thrombosis/virology
9.
Glob Heart ; 16(1): 47, 2021.
Article in English | MEDLINE | ID: covidwho-1335342

ABSTRACT

Background: The implications of city lockdown on vital signs during the COVID-19 outbreak are unknown. Objective: We longitudinally tracked vital signs using data from wearable sensors and determined associations with anxiety and depression. Methods: We selected all participants in the HUAWEI Heart Study from Wuhan and four nearby large provincial capital cities (Guangzhou, Chongqing, Hangzhou, Zhengzhou) and extracted all data from 26 December 2019 (one month before city lockdown) to 21 February 2020. Sleep duration and quality, daily steps, oxygen saturation and heart rate were collected on a daily basis. We compared the vital signs before and after the lockdown using segmented regression analysis of the interrupted time series. The depression and anxiety cases were defined as scores ≥8 on the Hospital Anxiety and Depression Scale depression and anxiety subscales [HADS-D and HADS-A] in 727 participants who finished the survey. Results: We included 19,960 participants (mean age 36 yrs, 90% men). Compared with pre-lockdown, resting heart rate dropped immediately by 1.1 bpm after city lockdown (95% confidence interval [CI]: -1.8, -0.4). Sleep duration increased by 0.5 hour (95% CI: 0.3, 0.8) but deep sleep ratio decreased by 0.9% (95% CI: -1.2, -0.6). Daily steps decreased by 3352 steps (95% CI: -4333, -2370). Anxiety and depression existed in 26% and 17% among 727 available participants, respectively, and associated with longer sleep duration (0.2 and 0.1 hour, both p < 0.001). Conclusions: Lockdown of Wuhan in China was associated with an adverse vital signs profile (reduced physical activity, heart rate, and sleep quality, but increased sleep duration). Wearable devices in combination with mobile-based apps may be useful to monitor both physical and mental health. Clinical trial registration: The trial is registered at Chinese Clinical Trial Registry (ChiCTR) website (ChiCTR-OOC-17014138).


Subject(s)
COVID-19/epidemiology , Communicable Disease Control , Exercise , Heart Rate , Oxygen/metabolism , Public Policy , Sleep , Adult , Anxiety/psychology , China/epidemiology , Cities/epidemiology , Depression/psychology , Female , Humans , Interrupted Time Series Analysis , Male , Middle Aged , Oximetry , Retrospective Studies , SARS-CoV-2 , Vital Signs , Wearable Electronic Devices , Young Adult
10.
Proc Natl Acad Sci U S A ; 118(26)2021 06 29.
Article in English | MEDLINE | ID: covidwho-1276011

ABSTRACT

Patients with severe COVID-19 infection exhibit a low level of oxygen in affected tissue and blood. To understand the pathophysiology of COVID-19 infection, it is therefore necessary to understand cell function during hypoxia. We investigated aspects of human monocyte activation under hypoxic conditions. HMGB1 is an alarmin released by stressed cells. Under normoxic conditions, HMGB1 activates interferon regulatory factor (IRF)5 and nuclear factor-κB in monocytes, leading to expression of type I interferon (IFN) and inflammatory cytokines including tumor necrosis factor α, and interleukin 1ß, respectively. When hypoxic monocytes are activated by HMGB1, they produce proinflammatory cytokines but fail to produce type I IFN. Hypoxia-inducible factor-1α, induced by hypoxia, functions as a direct transcriptional repressor of IRF5 and IRF3. As hypoxia is a stressor that induces secretion of HMGB1 by epithelial cells, hypoxia establishes a microenvironment that favors monocyte production of inflammatory cytokines but not IFN. These findings have implications for the pathogenesis of COVID-19.


Subject(s)
Cell Hypoxia/immunology , Hypoxia-Inducible Factor 1, alpha Subunit/immunology , Monocytes/immunology , COVID-19/immunology , Cells, Cultured , Cytokines/immunology , Humans , Interferon Regulatory Factors/metabolism , Interferon Type I/immunology , Interferon Type I/metabolism , Interleukin-1beta/metabolism , Monocytes/metabolism , NF-kappa B/immunology , NF-kappa B/metabolism , Oxygen/metabolism , SARS-CoV-2/immunology , Tumor Necrosis Factor-alpha/metabolism
12.
Nutrients ; 13(6)2021 Jun 20.
Article in English | MEDLINE | ID: covidwho-1273493

ABSTRACT

The interplay between inflammation and oxidative stress is a vicious circle, potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. This single-center retrospective study investigated micronutrient levels under Se and Zn supplementation in critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and explored potential relationships with immunological and clinical parameters. According to intensive care unit (ICU) standard operating procedures, patients received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and clinical data were extracted from the patient data management system on admission and after 10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 patients (64%) survived to ICU discharge. On admission, the majority of patients had low Se status biomarkers and Zn levels, along with elevated inflammatory parameters. Se supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p = 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with CRP (rs = -0.495), PCT (rs = -0.413), IL-6 (rs = -0.429), IL-1ß (rs = -0.440) and IL-10 (rs = -0.461). Positive associations were found for CD8+ T cells (rs = 0.636), NK cells (rs = 0.772), total IgG (rs = 0.493) and PaO2/FiO2 ratios (rs = 0.504). In addition, survivors tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075). Sufficient Se and Zn levels may potentially be of clinical significance for an adequate immune response in critically ill patients with severe COVID-19 ARDS.


Subject(s)
COVID-19/drug therapy , Critical Illness/therapy , Deficiency Diseases/drug therapy , Dietary Supplements , Micronutrients/therapeutic use , Selenium/therapeutic use , Zinc/therapeutic use , Aged , C-Reactive Protein/metabolism , COVID-19/blood , COVID-19/immunology , Deficiency Diseases/complications , Humans , Immune System/drug effects , Inflammation/blood , Inflammation/drug therapy , Intensive Care Units , Interleukins/blood , Male , Micronutrients/blood , Micronutrients/deficiency , Middle Aged , Oxygen/metabolism , Respiratory Distress Syndrome/drug therapy , Retrospective Studies , SARS-CoV-2 , Selenium/blood , Selenium/deficiency , Selenoprotein P/blood , Severity of Illness Index , Zinc/blood , Zinc/deficiency
13.
J Clin Lab Anal ; 35(7): e23811, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1252001

ABSTRACT

BACKGROUND: To explore the clinical manifestation, imaging examination, and serology of patients with novel coronavirus pneumonia (COVID-19) between China and overseas. METHODS: Ninety patients with COVID-19 who admitted to Fuzhou Pulmonary Hospital from January 23, 2020, to May 1, 2020, were included in this retrospective study. They were divided into domestic group and overseas group according to the origin regions. The clinical manifestations, imaging examination, serology, treatment, and prognosis between the two groups were compared and analyzed. RESULTS: The clinical manifestations of patients in the two groups mainly included fever (83.1% and 47.4%), cough (62% and 31.6%), expectoration (47.9% and 31.6%), anorexia (28.2% and 47.4%), fatigue (21.1% and 10.5%), and dyspnea (22.5% and 0%). The main laboratory characteristics in the two groups were decreased lymphocyte count, increased lactate dehydrogenase, decreased oxygenation index, decreased white blood cell count, increased erythrocyte sedimentation rate (ESR), and increased C-reactive protein. The computed tomography (CT) examinations of chest showed bilateral and peripheral involvement, with multiple patch shadows and ground glass shadows. However, pleural effusions were rare. CONCLUSION: Fever, cough, and dyspnea are more common in domestic cases than overseas cases. However, patients with COVID-19 from overseas may have the symptoms of loss of taste and smell that domestic cases do not have.


Subject(s)
COVID-19/virology , Pneumonia/virology , SARS-CoV-2/physiology , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , China/epidemiology , Female , Humans , Male , Middle Aged , Oxygen/metabolism , Pneumonia/epidemiology , Prognosis , Young Adult
14.
J Pediatr ; 237: 143-147, 2021 10.
Article in English | MEDLINE | ID: covidwho-1242546

ABSTRACT

OBJECTIVE: To assess whether use of an N95 mask by children is associated with episodes of desaturation or respiratory distress. STUDY DESIGN: Twenty-two healthy children were assigned at random to 1 of 2 groups: one group wearing N95 masks without an exhalation valve and the other group wearing N95 masks with an exhalation valve. We tracked changes in partial pressure of end-tidal carbon dioxide (PETCO2), oxygen saturation, pulse rate, and respiratory rate over 72 minutes of mask use. All subjects were monitored every 15 minutes, the first 30 minutes while not wearing a mask and the next 30 minutes while wearing a mask. They then performed a 12-minute walking test. RESULTS: The children did not experience a statistically significant change in oxygen saturation or pulse rate during the study. There were significant increases in respiratory rate and PETCO2 in the children wearing an N95 mask without an exhalation valve, whereas these increases were seen in the children wearing a mask with an exhalation valve only after the walking test. CONCLUSIONS: The use of an N95 mask could potentially cause breathing difficulties in children if the mask does not have an exhalation valve, particularly during a physical activity. We believe that wearing a surgical mask may be more appropriate for children.


Subject(s)
N95 Respirators/adverse effects , Respiratory Insufficiency/etiology , Biomarkers/metabolism , Carbon Dioxide/metabolism , Child , Child, Preschool , Exercise/physiology , Female , Heart Rate , Humans , Male , Oxygen/metabolism , Respiratory Function Tests , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/metabolism , Respiratory Rate , Risk Factors , Walk Test
15.
Med Hypotheses ; 146: 110421, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1233540

ABSTRACT

BACKGROUND: Infection with SARS-CoV-2 is responsible for the COVID-19 crisis affecting the whole world. This virus can provoke acute respiratory distress syndrome (ARDS) leading to overcrowed the intensive care unit (ICU). Over the last months, worldwide experience demonstrated that the ARDS in COVID-19 patients are in many ways "atypical". The mortality rate in ventilated patients is high despite the application of the gold standard treatment (protective ventilation, curare, prone position, inhaled NO). Several studies suggested that the SARS-CoV-2 could interact negatively on red blood cell homeostasis. Furthermore, SarsCov2 creates Reactive Oxygen Species (ROS), which are toxic and generate endothelial dysfunction. Hypothesis/objective(s) We hypothesis that HEMO2Life® administrated intravenously is safe and could help symptomatically the patient condition. It would increase arterial oxygen content despite lung failure and allow better tissue oxygenation control. The use of HEMO2Life® is also interesting due to its anti-oxidative effect preventing cytokine storm induced by the SARS-CoV-2. Evaluation of the hypothesis: Hemarina is based on the properties of the hemoglobin of the Arenicola marina sea-worm (HEMO2Life®). This extracellular hemoglobin has an oxygen capacity 40 times greater than the hemoglobin of vertebrates. Furthermore, the size of this molecule is 250 times smaller than a human red blood cell, allowing it to diffuse in all areas of the microcirculation, without diffusing outside the vascular sector. It possesses an antioxidative property du a Superoxide Dismutase Activity. This technology has been the subject of numerous publications and HEMO2Life® was found to be well-tolerated and did not induce toxicity. It was administered intravenously to hamsters and rats, and showed no acute effect on heart rate and blood pressure and did not cause microvascular vasoconstriction. In preclinical in vivo models (mice, rats, and dogs), HEMO2Life® has enabled better tissue oxygenation, especially in the brain. This molecule has already been used in humans in organ preservation solutions and the patients showed no abnormal clinical signs. CONSEQUENCES OF THE HYPOTHESIS: The expected benefits of HEMO2Life® for COVID-19 patients are improved survival, avoidance of tracheal intubation, shorter oxygen supplementation, and the possibility of treating a larger number of patients as molecular respirator without to use an invasive machine.


Subject(s)
COVID-19/complications , COVID-19/therapy , Hemoglobins/therapeutic use , Hypoxia/etiology , Hypoxia/therapy , Models, Biological , Oxygen/administration & dosage , Animals , COVID-19/physiopathology , Cricetinae , Dogs , Hemoglobins/administration & dosage , Hemoglobins/metabolism , Humans , Hypoxia/physiopathology , Injections, Intravenous , Mice , Oxidative Stress/drug effects , Oxygen/metabolism , Pandemics , Rats , SARS-CoV-2
16.
J Med Virol ; 93(2): 1023-1028, 2021 02.
Article in English | MEDLINE | ID: covidwho-1196468

ABSTRACT

BACKGROUND: We sought to evaluate the effect of tocilizumab (TCB), a recombinant humanized monoclonal antibody against soluble interleukin-6 receptors, in patients hospitalized for coronavirus disease 2019 (COVID-19). METHODS: We included all patients with laboratory-confirmed COVID-19 who had completed hospitalization between March 10, 2020 and April 10, 2020 with follow-up through April 20, 2020. Patients who received TCB in addition to standard of care within 48 h of admission were matched in a 1:2 fashion to a similar cohort who received standard of care alone. Clinical outcomes were compared between matched groups. The primary outcome was de-escalation in oxygen therapy. Secondary outcomes were in-hospital death, septic shock, and acute kidney injury (AKI) requiring hemodialysis. RESULTS: Out of 77 patients who received TCB in addition to standard of care, 34% (n = 26) received TCB within 48 h of admission. One-to-two propensity matching identified 20 versus 40 patients in the TCB and no-TCB treatment arms. In the TCB group, an improvement in oxygenation was observed in 80% (n = 16) of the patients by 7 days post TCB administration. After matching, there was no difference in clinical outcomes between TCB and no-TCB patients. In-hospital death: 10% versus 8%; p = .823, septic shock: 10% versus 11%, p = .912, AKI requiring hemodialysis (10% vs. 13%; p = .734). CONCLUSIONS: Early treatment with TCB in patients admitted for COVID-19 led to an improvement in their oxygen status during hospitalization. This change however did not translate into improved survival when compared to a matched cohort with a similar clinical profile.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/complications , COVID-19/therapy , Hospitalization/statistics & numerical data , Acute Kidney Injury/virology , Adult , Aged , Female , Hospital Mortality , Humans , Male , Middle Aged , Oxygen/metabolism , Receptors, Interleukin-6/antagonists & inhibitors , Renal Dialysis , Retrospective Studies , Shock, Septic/virology , Time Factors , Treatment Outcome , United States
17.
J Med Virol ; 93(3): 1443-1448, 2021 03.
Article in English | MEDLINE | ID: covidwho-1196454

ABSTRACT

Our study intended to longitudinally explore the prediction effect of immunoglobulin A (IgA) on pulmonary exudation progression in COVID-19 patients. The serum IgA was tested with chemiluminescence method. Autoregressive moving average model was used to extrapolate the IgA levels before hospital admission. The positive rate of IgA and IgG in our cohort was 97% and 79.0%, respectively. In this study, the IgA levels peaks within 10-15 days after admission, while the IgG levels peaks at admission. We found that the time difference between their peaks was about 10 days. Viral RNA detection results showed that the positive rate in sputum and feces were the highest. Blood gas analysis showed that deterioration of hypoxia with the enlargement of pulmonary exudation area. And alveolar-arterial oxygen difference and oxygenation index were correlated with IgA and IgG. The results of biopsy showed that the epithelium of lung was exfoliated and the mucosa was edematous. In severe COVID-19 patients, the combination of IgA and IgG can predict the progress of pulmonary lesions and is closely related to hypoxemia and both also play an important defense role in invasion and destruction of bronchial and alveolar epithelium by SARS-CoV-2.


Subject(s)
COVID-19/pathology , COVID-19/virology , Immunoglobulin A/blood , Immunoglobulin G/blood , Sputum/virology , Aged , Alveolar Epithelial Cells/metabolism , Alveolar Epithelial Cells/virology , Antibodies, Viral/blood , Bronchi/metabolism , Bronchi/virology , COVID-19/blood , COVID-19/metabolism , Female , Humans , Hypoxia/blood , Hypoxia/metabolism , Male , Middle Aged , Mucous Membrane/metabolism , Mucous Membrane/virology , Oxygen/metabolism , Pulmonary Alveoli/metabolism , Pulmonary Alveoli/virology , RNA, Viral/genetics , SARS-CoV-2/genetics
18.
Viruses ; 12(11)2020 10 25.
Article in English | MEDLINE | ID: covidwho-896046

ABSTRACT

The ability to detect and respond to varying oxygen tension is an essential prerequisite to life. Several mechanisms regulate the cellular response to oxygen including the prolyl hydroxylase domain (PHD)/factor inhibiting HIF (FIH)-hypoxia inducible factor (HIF) pathway, cysteamine (2-aminoethanethiol) dioxygenase (ADO) system, and the lysine-specific demethylases (KDM) 5A and KDM6A. Using a systems-based approach we discuss the literature on oxygen sensing pathways in the context of virus replication in different tissues that experience variable oxygen tension. Current information supports a model where the PHD-HIF pathway enhances the replication of viruses infecting tissues under low oxygen, however, the reverse is true for viruses with a selective tropism for higher oxygen environments. Differences in oxygen tension and associated HIF signaling may play an important role in viral tropism and pathogenesis. Thus, pharmaceutical agents that modulate HIF activity could provide novel treatment options for viral infections and associated pathological conditions.


Subject(s)
Oxygen/metabolism , Signal Transduction , Viral Tropism , Virus Replication , Viruses/pathogenicity , Animals , Humans , Hypoxia , Hypoxia-Inducible Factor 1/metabolism , Mice , Repressor Proteins/metabolism , Viruses/classification , Viruses/metabolism
19.
J Atheroscler Thromb ; 28(4): 406-416, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1170541

ABSTRACT

A questionnaire on COVID-19-related thrombosis in patients hospitalized before Aug 31, 2020, was sent to 399 hospitals throughout Japan. Responses were received from 111 (27.8%) with information on 6,202 COVID-19 patients. Of these, 333 and 56 required ventilation or extracorporeal membrane oxygenation (ECMO), respectively, and 212 died (3.4%). D-dimer levels were measured in 75.0% of the patients, revealing that 9.2% and 7.6% exhibited D-dimer increases of 3-8-fold and ≥8-fold the reference value, respectively. Thrombotic events occurred in 108 patients (1.86% of the 5,807 patients with available data) including symptomatic cerebral infarction in 24, myocardial infarction in 7, deep vein thrombosis in 41, pulmonary thromboembolism in 30, and other thrombotic events in 22. Some patients developed multiple thrombotic events. Thrombosis occurred in 32 patients with mild or moderate COVID-19 severity (0.59% of those with data available) and in 52 patients on ventilation or ECMO (13.5% of severe patients for whom data were available). Thrombosis occurred in 67 patients during worsening clinical condition and in 26 during recovery. Anticoagulant therapy was provided to 893 patients (14.6% of the 6,119 patients with available data), the main reasons being provided as elevated D-dimer levels and worsening clinical condition.


Subject(s)
COVID-19/complications , Thrombosis/complications , Aged , Anticoagulants/therapeutic use , COVID-19/epidemiology , Extracorporeal Membrane Oxygenation , Female , Fibrin Fibrinogen Degradation Products/analysis , Hospitalization , Humans , Incidence , Japan/epidemiology , Male , Middle Aged , Myocardial Infarction , Oxygen/metabolism , Respiration, Artificial , Surveys and Questionnaires , Thrombosis/epidemiology
SELECTION OF CITATIONS
SEARCH DETAIL
...